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Short-term late-generation antibiotics versus longer term penicillin for acute streptococcal pharyngitis in children.
[acute rheumatic fever]
The
standard
duration
of
treatment
for
children
with
acute
group
A
beta
hemolytic
streptococcus
(
GABHS
)
pharyngitis
with
oral
penicillin
is
10
days
.
Shorter
duration
antibiotics
may
have
comparable
efficacy
.
To
summarize
the
evidence
regarding
the
efficacy
of
two
to
six
days
of
newer
oral
antibiotics
(
short
duration
)
compared
to
10
days
of
oral
penicillin
(
standard
duration
)
in
treating
children
with
acute
GABHS
pharyngitis
.
We
searched
the
Cochrane
Central
Register
of
Controlled
Trials
(
CENTRAL
2012
,
Issue
3
)
which
contains
the
Cochrane
Acute
Respiratory
Infections
Group
's
Specialized
Register
,
MEDLINE
(
January
1966
to
March
week
3
,
2012
)
and
EMBASE
(
January
1990
to
April
2012
)
.
Randomized
controlled
trials
(
RCTs
)
comparing
short
duration
oral
antibiotics
to
standard
duration
oral
penicillin
in
children
aged
1
to
18
years
with
acute
GABHS
pharyngitis
.
Two
review
authors
scanned
the
titles
and
abstracts
of
retrieved
citations
and
applied
the
inclusion
criteria
.
We
retrieved
included
studies
in
full
,
and
extracted
data
.
Two
review
authors
independently
assessed
trial
quality
.
We
included
20
studies
with
13
,
102
cases
of
acute
GABHS
pharyngitis
.
The
updated
search
did
not
identify
any
new
eligible
studies
;
the
majority
of
studies
were
at
high
risk
of
bias
.
However
,
the
majority
of
the
results
were
consistent
.
Compared
to
standard
duration
treatment
,
the
short
duration
treatment
studies
had
shorter
periods
of
fever
(
mean
difference
(
MD
)
-
0
.
30
days
,
95
%
confidence
interval
(
CI
)
-
0
.
45
to
-
0
.
14
)
and
throat
soreness
(
MD
-
0
.
50
days
,
95
%
CI
-
0
.
78
to
-
0
.
22
)
;
lower
risk
of
early
clinical
treatment
failure
(
odds
ratio
(
OR
)
0
.
80
,
95
%
CI
0
.
67
to
0
.
94
)
;
no
significant
difference
in
early
bacteriological
treatment
failure
(
OR
1
.
08
,
95
%
CI
0
.
97
to
1
.
20
)
or
late
clinical
recurrence
(
OR
0
.
95
,
95
%
CI
0
.
83
to
1
.
08
)
.
However
,
the
overall
risk
of
late
bacteriological
recurrence
was
worse
in
the
short
duration
treatment
studies
(
OR
1
.
31
,
95
%
CI
1
.
16
to
1
.
48
)
,
although
no
significant
differences
were
found
when
studies
of
low
dose
azithromycin
(
10
mg
/
kg
)
were
eliminated
(
OR
1
.
06
,
95
%
CI
0
.
92
to
1
.
22
)
.
Three
studies
reported
long
duration
complications
.
Out
of
8135
cases
of
acute
GABHS
pharyngitis
,
only
six
cases
in
the
short
duration
treatment
versus
eight
in
the
standard
duration
treatment
developed
long
-term
complications
in
the
form
of
glomerulonephritis
and
acute
rheumatic
fever
,
with
no
statistically
significant
difference
(
OR
0
.
53
,
95
%
CI
0
.
17
to
1
.
64
)
.
Three
to
six
days
of
oral
antibiotics
had
comparable
efficacy
compared
to
the
standard
duration
10
-
day
course
of
oral
penicillin
in
treating
children
with
acute
GABHS
pharyngitis
.
.
In
areas
where
the
prevalence
of
rheumatic
heart
disease
is
still
high
,
our
results
must
be
interpreted
with
caution
.
Diseases
Validation
Diseases presenting
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated